The Perioperative Morbidity of Transurethral Resection of Bladder Tumor: Implications for Quality Improvement

To characterize the perioperative morbidity of transurethral resection of bladder tumor (TURBT) in order to identify important determinants of both quality and cost in the delivery bladder cancer care.

We identified 24,100 patients aged 18-89 years who underwent TURBT from 2010-2015 in the National Surgical Quality Improvement Program database. Multivariable logistic regression was performed to evaluate the associations of patient features and tumor size (<2cm, 2-5 cm, or >5cm) with 30-day perioperative outcomes.

Thirty-day post-operative complications occurred in 5.1% of patients, perioperative blood transfusion in 1.5% of patients, hospital readmission in 3.8% of patients, reoperation in 1.5% of patients, and mortality in 0.8% of patients. The most common reasons for readmission were bleeding (29%) and infectious (21%) complications. Although several patient features were associated with increased perioperative morbidity on multivariable analysis, including congestive heart failure, renal failure, higher ASA class, and dependent functional status, only larger tumor size was independently associated with increased risks of all perioperative endpoints.

Perioperative morbidity following TURBT is substantial and represents an important target for quality improvement. Extent of resection, patient functional status, and specific comorbidities are independently associated with increased risks of perioperative morbidity and mortality. These results have implications for patient counseling, perioperative management, and quality improvement programs.

Urology. 2018 Oct 23 [Epub ahead of print]

Jorge Pereira, Gyan Pareek, Catrina Mueller-Leonhard, Zheng Zhang, Ali Amin, Anthony Mega, Christopher Tucci, Dragan Golijanin, Boris Gershman

Columbia University Division of Urology, Mount Sinai Medical Center, Miami Beach, FL., Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI; Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI., Lifespan Oncology Clinical Research, The Miriam Hospital, Providence, RI., Department of Biostatistics, Brown University, Providence, RI., Department of Pathology & Laboratory Medicine, The Miriam Hospital, Providence, RI., Department of Hematology/Oncology, The Miriam Hospital, Providence, RI., Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI., Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI; Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI. Electronic address: .